Provider Demographics
NPI:1215673546
Name:AWKWARD, JISZARRA
Entity type:Individual
Prefix:
First Name:JISZARRA
Middle Name:
Last Name:AWKWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20995 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:MD
Mailing Address - Zip Code:20620-2347
Mailing Address - Country:US
Mailing Address - Phone:301-994-1099
Mailing Address - Fax:301-994-1108
Practice Address - Street 1:20995 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:MD
Practice Address - Zip Code:20620-2347
Practice Address - Country:US
Practice Address - Phone:301-994-1099
Practice Address - Fax:301-994-1108
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT24196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist